ISSN 2415-3060 (print), ISSN 2522-4972 (online)
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JMBS 2021, 6(2): 189–195
https://doi.org/10.26693/jmbs06.02.189
Physical Therapy and Ergotherapy

The Effect of Respiratory Physical Therapy on the Lеvel of Free Fluid in Pleural Cavities after Cardiac Surgery

Vitomskyi V. V. 1,2
Abstract

The purpose of the study was to investigate the effect of respiratory physical therapy on the level of free fluid in the pleural cavities after cardiac surgery. Materials and methods. The study involved 138 patients. The patients were randomly divided into three groups: control (respiratory physical therapy was limited to cough), group of incentive spirometry (in classes with a physical therapist patients performed additional 3 approaches of 10 breaths through the simulator; they received recommendations for hourly performance of a similar number of cycles of exercise), a group of patients who received additional respiratory physical therapy with positive expiratory pressure in the form of exhalation into a bottle of water through a tube (number of repetitions and recommendations are similar to those received by the previous group). All groups underwent the same protocol of mobilization and use of therapeutic physical exercises in the procedure of therapeutic gymnastics. Performing exercises with breathing simulators began on the 1st postoperative day. Results and discussion. The results of ultrasound examinations of the level of free fluid in the left and right pleural cavities, which were performed according to the postoperative protocol, were studied. The first ultrasound examination, which was analyzed, was performed on the seventh postoperative day, and in the absence of the study on this day, the data of the next study were selected with the registration of the postoperative day number. In addition, the indicators of the final studies of the level of free fluid of the pleural cavities were compared. The position of the patient during the examinations was a sitting one. Analysis of the level of pleural effusion did not establish the benefits of using additional respiratory physical therapy in both groups. The results of studies of the right pleural cavities did not differ in groups of patients, but those of the left ones differed. Conclusion. Pairwise comparison of the groups confirmed the presence of statistically worse results of examinations of the left pleural cavities in the group of incentive spirometry, as well as the absence of statistical differences between the results of the other two groups. The negative effect of incentive spirometry should be confirmed by additional studies, as its effect differed for the results of the left (negative effect) and right (no advantage) pleural cavity

Keywords: pleural exudate, effusion, transudate, breathing exercises

Full text: PDF (Ukr) 352K

References
  1. Labidi M, Baillot R, Dionne B, Lacasse Y, Maltais F, Boulet LP. Pleural effusions following cardiac surgery: prevalence, risk factors, and clinical features. Chest. 2009; 136(6): 1604-11. PMID: 19581352. https://doi.org/10.1378/chest.09-0689
  2. Heidecker J, Sahn SA. The spectrum of pleural effusions after coronary artery bypass grafting surgery. Clinics in chest medicine. 2006; 27(2): 267-83. PMID: 16716818. https://doi.org/10.1016/j.ccm.2006.01.007
  3. Sadikot RT, Rogers JT, Cheng DS, Moyers P, Rodriguez M, Light RW. Pleural fluid characteristics of patients with symptomatic pleural effusion after coronary artery bypass graft surgery. Arch Intern Med. 2000; 160(17): 2665-8. PMID: 10999982. https://doi.org/10.1001/archinte.160.17.2665
  4. Light RW. Pleural effusions after coronary artery bypass graft surgery. Curr Opin Pulmon Med. 2002; 8(4): 308-11. PMID: 12055394. https://doi.org/10.1097/00063198-200207000-00011
  5. Charniot JC, Zerhouni K, Kambouchner M, Martinod E, Vignat N, Azorin J, et al. Persistent symptomatic pleural effusion following coronary bypass surgery: clinical and histologic features, and treatment. Heart and vessels. 2007; 22(1): 16-20. PMID: 17285440. https://doi.org/10.1007/s00380-006-0930-4
  6. Özülkü M, Aygün F. Effect of using pump on postoperative pleural effusion in the patients that underwent CABG. Brazil J Cardiovasc Surg. 2015; 30(4): 466-73. https://doi.org/10.5935/1678-9741.20150029
  7. Light RW, Rogers JT, Moyers JP, Lee YG, Rodriguez RM, Alford Jr WC, et al. Prevalence and clinical course of pleural effusions at 30 days after coronary artery and cardiac surgery. Am J Respiratory & Critical Care Med. 2001; 166(12): 1567-71. PMID: 12406850. https://doi.org/10.1164/rccm.200203-184OC
  8. Vitomskyi V. The impact of mobilization and other factors on pleural effusion in patients undergoing cardiac surgical procedures. J Physical Educ Sport. 2020; 20: 2167-73.
  9. Rossolatou M, Papageorgiou D, Toylia G, Vasilopoulos G. Pleural effusion in patients undergoing coronary artery bypass graft and valve replacement: a population study. Health & Research J. 2018; 4(3): 167-82. https://doi.org/10.12681/healthresj.19293
  10. Hurlburt D, Myers ML, Lefcoe M, Goldbach M. Pleuropulmonary morbidity: internal thoracic artery versus saphenous vein graft. Ann Thorac Surg. 1990; 50(6): 959-64. https://doi.org/10.1016/0003-4975(90)91129-Y
  11. Burgess III GE, Cooper Jr JR, Marino RJ, Peuler MJ, Mills NL, Ochsner JL. Pulmonary effect of pleurotomy during and after coronary artery bypass with internal mammary artery versus saphenous vein grafts. J Thorac Cardiovasc Surg. 1978; 76(2): 230-4. https://doi.org/10.1016/S0022-5223(19)41144-6
  12. Peng MJ, Vargas FS, Cukier A, Terra-Filho M, Teixeira LR, Light RW. Postoperative pleural changes after coronary revascularization: comparison between saphenous vein and internal mammary artery grafting. Chest. 1992; 101(2): 327-30. PMID: 1735249. https://doi.org/10.1378/chest.101.2.327
  13. Light RW, Rogers JT, Cheng DS, Rodriguez RM. Large pleural effusions occurring after coronary artery bypass grafting. Ann Intern Med. 1999: 130(11): 891-6. PMID: 10375337. https://doi.org/10.7326/0003-4819-130-11-199906010-00004
  14. Jensen L, Yang L. Risk factors for postoperative pulmonary complications in coronary artery bypass graft surgery patients. Europ J Cardiovasc Nursing. 2007; 6(3): 241-6. PMID: 17347049. https://doi.org/10.1016/J.EJCNURSE.2006.11.001
  15. Van De Water JM. The treatment of pleural effusion complicating pneumonia. Chest. 1970; 57(3): 259-62. PMID: 5417667. https://doi.org/10.1378/chest.57.3.259
  16. Vitomskyi VV, Al-Hawamdeh KM, Vitomska MV, Gavreliuk SV. Porivniannia pokaznykiv terapevtychnoho aliansu za rezultatamy anketuvannia kardiokhirurhichnykh patsiientiv ta yikh fizychnykh terapevtiv [Comparison of the Therapeutic Alliance Indicators according to the Results of the Survey of Cardiosurgical Patients and their Physical Therapists]. Ukr Ž Med Bìol Sport. 2020; 5(6): 275-81. https://doi.org/10.26693/jmbs05.06.275
  17. Vitomskyi V, Al-Hawamdeh K, Vitomska M, Lazarіeva O, Haidai O. The effect of incentive spirometry on pulmonary function recovery and satisfaction with physical therapy of cardiac surgery patients. Advanc Rehabilit. 2021; 35(1): 9-16. https://doi.org/10.5114/areh.2020.102020
  18. Fysh ETH, Smallbone P, Mattock N, McCloskey C, Litton E, Wibrow B, et al. Clinically Significant Pleural Effusion in Intensive Care: A Prospective Multicenter Cohort Study. Crit Care Explor. 2020; 2(1): e0070. PMID: 32166290. PMCID: PMC7063904. doi:10.1097/CCE.0000000000000070
  19. Westerdahl E, Lindmark B, Almgren SO, Tenling A. Chest physiotherapy after coronary artery bypass graft surgery-a comparison of three different deep breathing techniques. J Rehabilit Med. 2001; 33(2): 79-84. PMID: 11474953. https://doi.org/10.1080/165019701750098920
  20. Nozawa E, Coimbra VRM, Cruz FCSG, Silva SHS, França PFB, Galas FRG, et al. Late-breaking abstract: Early mobilization optimizing fluid of mediastinal and thoracic tube in the postoperative patients after coronary artery bypass surgery. Eur Respirat J. 2015; 46 (suppl 59): PA1502. https://doi.org/10.1183/13993003.congress-2015.PA1502
  21. Moradian ST, Najafloo M, Mahmoudi H, Ghiasi MS. Early mobilization reduces the atelectasis and pleural effusion in patients undergoing coronary artery bypass graft surgery: A randomized clinical trial. J Vasc Nursing. 2017; 35(3): 141-5. PMID: 28838589. https://doi.org/10.1016/j.jvn.2017.02.001
  22. Santos E, Junior JS, Melo F, Assis Filho M, Vidal M, Silva J, et al. Effect of positive airway pressure added to conventional chest physiotherapy in resolution of pleural effusion after drainage: A randomised controlled trial. J Physiother. 2015; 61(2): 93. PMID: 25744852. https://doi.org/10.1016/j.jphys.2014.11.016
  23. Valenza-Demet G, Valenza MC, Cabrera-Martos I, Torres-Sánchez I, Revelles-Moyano F. The effects of a physiotherapy programme on patients with a pleural effusion: a randomized controlled trial. Clin Rehabil. 2014; 28(11): 1087-95. PMID: 24733648. https://doi.org/10.1177/0269215514530579
  24. Manapunsopee S, Thanakiatpinyo T, Wongkornrat W, Chuaychoo B, Thirapatarapong W. Effectiveness of Incentive Spirometry on Inspiratory Muscle Strength After Coronary Artery Bypass Graft Surgery. Heart, Lung and Circulation. 2019; 29(8): 1180-6. PMID: 31735684. https://doi.org/10.1016/j.hlc.2019.09.009
  25. Jenkins SC, Soutar SA, Loukota JM, Johnson LC, Moxham J. Physiotherapy after Coronary artery surgery: are breathing exercises necessary? Thorax. 1989; 44(8): 634-9. PMID: 2799743. PMCID: PMC461992. https://doi.org/10.1136/thx.44.8.634